Introduction: Pheochromocytoma is a rare neuroendocrine tumor of the adrenal medulla that secretes catecholamines. Surgical treatment of pheochromocytoma remains a challenge for all clinicians, particularly anesthesiologists. The complexity of managing adrenal medullary tumors lies in the necessity of meticulous preoperative preparation, the risk of hemodynamic instability, and a well-coordinated, team-based approach to patient care. Despite existing guidelines for preoperative preparation and surgical technique selection, pheochromocytoma can surprise us. Case Report: We present the case of a 46-year-old female patient in whom an adrenal medullary tumor was discovered incidentally. Due to tumor growth and secretory activity, diagnostic evaluation and surgical treatment were indicated. The patient underwent appropriate preoperative preparation and laparoscopic surgery with initially well-regulated hemodynamic parameters. Intraoperatively, however, she experienced pronounced and refractory hemodynamic instability, which required prompt and coordinated action by the anesthesiology team. Recurrent hypertensive crises during surgical manipulation of the tumor and the unavailability of nitroprusside made the intraoperative course particularly challenging. Conclusion: Adequate preoperative preparation, medication availability and a hemodynamically stable patient do not guarantee an uneventful intraoperative course. A review of the literature highlights the link between tumor characteristics, intraoperative behavior, and preoperative strategy, indicating the need for further advancement in this field.
Nikolić et al. (Wed,) studied this question.